Anatomic lower urinary tract obstructions in boys are not a common problem in pediatric urology. 
Although there have been many studies reporting cases of posterior urethral valves, there have been relatively few regarding strictures in children despite the fact that strictures are actually seen more commonly than cases of posterior urethral valves.
However, urethral instrumentation is the main factor for urethral stricture.

We present the case of a 4 years old boy diagnosed of posterior urethral valves at birth. The urethral obstruction was managed with multiple surgeries including internal urethrotomy, holmium laser ablation of PUV, and urethroplasty with buccal mucosa. The patient was referred to our centre with an obliterative stenosis in the bulbar urethra, requiring a vesicostomy to void.
We evaluated anterograde and retrograde the urethra the a total obliterative stenosis in bulbar urethra was confirmed. Open urethroplasty was indicated and the video shows the surgery.

Perineal incision was made in order to dissect both end of the urethral. Endourological approach was used to indicate the stop in the urethra. A tension-free end-to-end anastomosis with interrupted suture 6/0 Monocryl was successful performed. 12ch catheter was inserted when the anastomosis was completed. Vesicostomy was maintain till urethrography demonstrated the absence of urethral fistula.

-	Open urethroplasty is the procedure of choice in complex and recurrent strictures. 
-	The combined approach can help locate both ends in obliterated strictures.
-	End-to-end anastomosis is successful in short strictures with tension-free anastomosis.

Continence 2S2 (2022) 100314
DOI: 10.1016/j.cont.2022.100314